Can My Insurance Company Selectively Review Certain Medical Records While Ignoring Others In Considering My LTD Benefits?

It is common practice by insurance companies to “cherry pick” medical records during the LTD review process, taking the claimant’s physician’s notes out of context in an attempt to validate the denial or termination of benefits. Often times, insurance companies will find one or two notes from a claimant’s physician that state he or she has improved or is feeling better and base the denial on those notes alone while ignoring all other pertinent medical records. There could be hundreds of pages of records and lab tests documenting disabling medical issues, but the insurance company will focus solely on those one or two sentences, usually taking them out of context, in order to deny or terminate a claimant’s benefits.

Unum unfairly terminates benefits after paying claimant for over ten years

This exact scenario occurred in the case of Hannon v. Unum Life Ins. Co, U.S. District. LEXIS 181381 (S.D.Ind November 26, 2013). In this case, the court granted summary judgment in favor of the Plaintiff, against Unum, who worked as a registered nurse but suffered from a connective tissue disorder called Ehler-Danlos syndrome. Hannon was paid LTD benefits by Unum for over 10 years, but after Unum performed a paper review of her records, it was determined that she was capable of performing full-time sedentary work. Hannon’s treating physicians all held the opinion that she was incapable of performing more than 4 hours of sedentary work a day due to her disabling condition. In her summary judgment motion, Hannon argued that Unum “cherry picked statements from her treating physician that supported the termination of benefits, while completely ignoring the entirety of her claim file comprised of over 2000 pages.” The court held that Unum took her doctor’s statement out of context and that Unum’s “selective review does not provide sufficient justification to terminate the LTD benefits that Unum paid continuously for ten years.” Interestingly, the court also found that Unum abused its discretion by basing the denial on her ability to perform household chores. The Seventh Circuit firmly stated that “casual equating of household work to work in the labor market cannot stand.” Gentle v. Barnhart, 430 F.3d 865, 867 (7th Cir. 2005).

It is important to note that the Court’s decision in Hannon suggests that when an insurance company pays benefits for a significant period of time (i.e. 10 years) it should make sure that when terminating benefits, the claimant’s condition has truly improved significantly and that this improvement is supported by convincing medical documentation. The court in the case at hand was highly suspicious of Unum’s motive for terminating benefits when its decision was based on a few pages of medical records taken completely out of context.

It is imperative that you communicate all of your issues to your treating physicians and make sure they are documenting your medical restrictions and limitations accurately. Too many times a claimant will state that they were unaware that their doctor was not documenting their complaints of pain or difficulties functioning. Without such documentation, your claim will likely be denied. This is why it is important to have legal counsel monitoring your claim even after your benefits have been approved, as there is no guarantee that your insurance company will continue to pay your benefits until you are 65.

Leave a comment or ask us a question

There are 2 comments

  • Bradley,

    Please feel free to contact our office to discuss your pending application and how we may be able to assist you in securing your benefits.

    Stephen JessupSep 11, 2014  #2

  • Dear Sir,

    I am just starting a LTD claim process with Cigna. That being said, can you please help understand the best process for the for submitting all pertinent medical records from multiple physiciansto Cigna. The Cigna claim clerk made an initial call and asked me to fax all of my records to their central facsimile station. However, I have a great amount of records and am concerned that parts of my fax will get missed or lost from altogether. Finally, I am a master at getting my medical records from my doctors and in fact, have records from spine surgeries going back to 2004 to present. In the initial claim process, is it appropriate to send Cigna as all medical records that I have available or should I be more selective in topic and date?

    Claiming LTD for: Multiple (x5) Lumbar spinal surgeries, CTD akin to Sjogren’s or Lupus and now an exacerbation w/ new cervical and thoracic spine decease.

    Thank you very much for providing so much help.

    BradleySep 11, 2014  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us